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Biopsy Of The Roof Of The Mouth

Oregon rates for HCPCS 42100

Takes a small piece of tissue from the roof of the mouth or from the uvula, the flap hanging at the back of the throat, so it can be examined under a microscope. Only a sample is taken and the rest of the area is left in place. It is done to find out what is behind a patch, sore, swelling or growth that has not settled on its own.

Rates data updated July 2026.

How much does Biopsy Of The Roof Of The Mouth cost?

$224

Typical negotiated rate. In Oregon, July 2026.

Insurers have agreed to pay about $224 for this service. The price depends on where it is billed: about $219 from a physician practice, and about $234 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 8 insurance carriers under federal price transparency rules.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$219$155 to $295
FacilityA hospital or hospital-owned outpatient department$234$166 to $288

How much rates vary

Facilitymedian $234 · 10th to 90th $129 to $363Professionalmedian $219 · 10th to 90th $115 to $389
$100$200$500$1K$2K$5Kfacility $234professional $219

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$281.84
Median
$380.19
Typical High
$7,943.28
Aetna
Setting
Professional
Modifier
Global
Typical Low
$104.71
Median
$158.49
Typical High
$616.60
Cigna
Setting
Facility
Modifier
Global
Typical Low
$158.49
Median
$158.49
Typical High
$1,949.84
Cigna
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$245.47
Typical High
$389.05
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$194.98
Median
$257.04
Typical High
$363.08
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$114.82
Median
$177.83
Typical High
$316.23
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$181.97
Median
$251.19
Typical High
$354.81
Pacific Source
Setting
Facility
Modifier
Global
Typical Low
$169.82
Median
$281.84
Typical High
$295.12
Providence
Setting
Facility
Modifier
Global
Typical Low
$112.20
Median
$177.83
Typical High
$316.23
Providence
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$275.42
Typical High
$371.54
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$3,548.13
Median
$5,011.87
Typical High
$6,025.60
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$208.93
Median
$288.40
Typical High
$398.11
United
Setting
Facility
Modifier
Global
Typical Low
$676.08
Median
$4,677.35
Typical High
$7,244.36
United
Setting
Professional
Modifier
Global
Typical Low
$151.36
Median
$245.47
Typical High
$380.19

Where Oregon sits

The same service costs 2.1 times more in Minnesota than in Hawaii. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Oregon· 3rd of 51

$224

MN $282HI $135

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.